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The influence of trust in the health care system on postpartum contraceptive choice

Angela Dempsey, Medical University of South Carolina, 2012

Project abstract

Public health experts have set goals to increase the proportion of pregnancies that are intended and decrease the proportion of pregnancies that are conceived within 18 months of a prior birth. Increasing the proportion of women using highly effective contraception postpartum is an important strategy to attain these goals. Highly effective methods with failure rates of less than 1% include long acting reversible contraception (IUDs and implants) as well as sterilization. These methods are currently underutilized among postpartum women. Our understanding of the patient-level behavioral factors associated with choice of highly effective contraception postpartum is limited. Such an understanding is needed to facilitate improved patient-centered counseling and to inform interventions to increase use of highly effective contraception postpartum.

Long acting reversible contraceptive methods and sterilization differ from other contraception in that a provider intervention is required for both initiation and discontinuation of the method. Based on this observation, we hypothesize that an individual's trust in the health care system, including trust in their providers, may be associated with their choice of highly effective contraception postpartum. This prospective, observational study aims to evaluate the association between trust in the health care system and choice of highly effective contraception postpartum among women receiving prenatal care and giving birth. Participants will complete questionnaires during early prenatal care and again postpartum to assess a range of patient-level factors including trust in the health care system. Their choice of postpartum contraception will be recorded. Variables and outcomes of interest will be described among the study population. Both bivariate and multivariate analyses will be conducted to describe the association between trust in the health care system and choice of highly effective contraception postpartum.


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